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McGuire E, Collin SM, Brown CS, Saito M. Community-Acquired Staphylococcus aureus Bacteremia Among People Who Inject Drugs: A National Cohort Study in England, 2017-2020. Clin Infect Dis 2024; 78:1443-1450. [PMID: 38315893 PMCID: PMC11175704 DOI: 10.1093/cid/ciae056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk of community-acquired Staphylococcus aureus bacteremia (CA-SAB), but little is known about clinical outcomes of CA-SAB in PWID compared with the wider population of patients with CA-SAB. METHODS Three national datasets were linked to provide clinical and mortality data on patients hospitalized with CA-SAB in England between 1 January 2017 and 31 December 2020. PWID were identified using the International Classification of Diseases, Tenth Revision code for "mental health and behavioral disorder due to opioid use" (F11). Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) for associations of PWID with 30-day all-cause mortality and 90-day hospital readmission. RESULTS In 10 045 cases of CA-SAB, 1612 (16.0%) were PWID. Overall, 796 (7.9%) patients died within 30 days of CA-SAB admission and 1189 (11.8%) patients were readmitted to hospital within 90 days of CA-SAB. In those without infective endocarditis, there was strong evidence of lower odds of mortality among PWID compared with non-PWID (aOR, 0.47 [95% confidence interval {CI}: .33-.68]; P < .001), whereas there was no association in CA-SAB case fatality with endocarditis (aOR, 1.40 [95% CI: .87-2.25]; P = .163). PWID were less likely to be readmitted within 90 days of CA-SAB (aOR, 0.79 [95% CI: .65-.95]; P = .011). CONCLUSIONS In this large cohort study of patients with CA-SAB in England, PWID had lower odds of death in the absence of endocarditis and lower odds of readmission within 90 days compared to non-PWID patients. This study highlights the overrepresentation of PWID among patients with CA-SAB nationally.
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Affiliation(s)
- Emma McGuire
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU), and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon M Collin
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Colin S Brown
- Healthcare-Associated Infection (HCAI), Fungal, Antimicrobial Resistance (AMR), Antimicrobial Use (AMU), and Sepsis Division, United Kingdom Health Security Agency (UKHSA), London, UK
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Sebastian A, Sebastian N, Arulthasan M, Simon R, Nicastro JM. Necrotizing Soft Tissue Infection Secondary to Streptococcus constellatus, Actinomyces odontolyticus, and Gemella morbillorum in an Intravenous Drug User: A Case Report and Literature Review. Cureus 2023; 15:e37314. [PMID: 37181983 PMCID: PMC10167094 DOI: 10.7759/cureus.37314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
A 53-year-old male with active IV heroin use presented with left upper extremity pain, erythema, swelling, and purulent foul-smelling drainage. Rapid diagnosis of necrotizing soft tissue infection (NSTI) was made based on clinical and radiologic findings. He was taken to the operating room for wound washouts and surgical debridements. The early microbiologic diagnosis was made based on intraoperative cultures. Successful treatment of NSTI in the setting of rare pathogens was achieved. The wound was ultimately treated with wound vac therapy, followed by primary delayed closure of the upper extremity and skin grafting of the forearm. We present a case of NSTI secondary to Streptococcus constellatus, Actinomyces odontolyticus, and Gemella morbillorum in an intravenous (IV) drug user, successfully treated with early surgical intervention.
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Affiliation(s)
| | | | | | - Ronald Simon
- Surgery, Maimonides Medical Center, Brooklyn, USA
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Self and professional treatment of skin and soft tissue infections among women who inject drugs: Implications for wound care provision to prevent endocarditis. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3. [PMID: 35813351 PMCID: PMC9262139 DOI: 10.1016/j.dadr.2022.100057] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Skin and soft tissue infections (SSTI) are common among people who inject drugs and can result in severe health consequences, including infective endocarditis. Numerous barriers to accessing care often prevent people who inject drugs from seeking healthcare including past negative healthcare experiences, transportation, and shame around drug use. These barriers can lead some people who inject drugs to self-care instead of seeking formal treatment. Methods: We explored the prevalence of SSTIs and associated treatment behaviors among women who inject drugs and sell sex (N = 114). Women reported their drug use and SSTI histories. Those who experienced an SSTI reported if they self-treated their SSTIs and/or sought formal treatment. Results: Half (50.0%) experienced at least one SSTI in the past 6 months. SSTIs were more common among those who injected painkillers (24.6% vs 8.8%, p = 0.02) and who had ever been treated for endocarditis (28.1% vs 10.5%, p = 0.02). SSTIs were less common among those who injected multiple times per day (17.9% vs 38.6%, p = 0.01) and always injected with a sterile syringe (19.3% vs 42.1%, p = 0.01). Among those who experienced an SSTI, most (85.7%) reported self-treating, and half (52.6%) sought formal care. The emergency room was the most common source of care (73.3%). Conclusions: When experiencing SSTIs, women often opted to self-treat rather than seek formal healthcare. A lack of formal care can lead to infections progressing to serious conditions, like endocarditis. Self-treatment with non-prescribed antibiotics may further result in antibiotic-resistant infections. Low threshold, stigma free, community-based wound care programs are warranted.
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Moran GJ, Chitra S, McGovern PC. Efficacy and Safety of Omadacycline Versus Linezolid in Acute Bacterial Skin and Skin Structure Infections in Persons Who Inject Drugs. Infect Dis Ther 2022; 11:517-531. [PMID: 35015255 PMCID: PMC8847501 DOI: 10.1007/s40121-021-00587-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/23/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Acute bacterial skin and skin structure infections (ABSSSI) represent one of the most common reasons for emergency department visits, and are frequent complications of intravenous drug use in persons who inject drugs (PWID). This study examined the efficacy and safety of omadacycline, versus linezolid, in PWID and persons who do not inject drugs, in the Phase 3 Omadacycline in Acute Skin and Skin Structure Infection (OASIS-1, OASIS-2) studies. Methods Eligible participants were aged ≥ 18 years with qualifying skin infections: wound infection, cellulitis, erysipelas, or major abscess. The primary efficacy endpoint was early clinical response (ECR) in the modified intent-to-treat (mITT) population, defined as survival with ≥ 20% reduction in lesion size at 48–72 h after the first dose of omadacycline or linezolid. Key secondary endpoints included investigator-assessed clinical response at the post-treatment evaluation (PTE) in the mITT and clinical per-protocol populations, and clinical response at PTE in the micro-mITT population. Safety was assessed based on adverse events (AEs) and standard clinical laboratory tests. Efficacy endpoints of clinical response at ECR and PTE were analyzed for the mITT and clinically evaluable (CE) PTE populations. Results In total, 1380 patients (822 PWID, 558 non-PWID) were included in this secondary analysis. Wound infections were reported more frequently in the PWID subgroup (72.8%) at baseline; cellulitis or erysipelas (43.9%) and major abscess (37.4%) were the most frequently reported baseline infections in the non-PWID subgroup. Clinical success rates at ECR and PTE in the mITT population, and at PTE in the CE population, were high for patients receiving omadacycline or linezolid. Severe or serious treatment-emergent AEs (TEAEs), and TEAEs leading to discontinuation, were infrequent. Conclusion This subgroup analysis showed that omadacycline was effective and well tolerated, regardless of PWID status.
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Affiliation(s)
- Gregory J Moran
- Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA, 91342, USA.
| | - Surya Chitra
- Paratek Pharmaceuticals, Inc., King of Prussia, PA, USA
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Castro-Granell V, Garin N, Jaén Á, Casado JL, Leal L, Cenoz S, Fuster-RuizdeApodaca MJ. Recreational Drug Use in People Living with HIV in Spain: Factors Associated with Drug Use and the Impact on Clinical Outcomes. AIDS Behav 2021; 25:3883-3897. [PMID: 33932187 PMCID: PMC8602223 DOI: 10.1007/s10461-021-03271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 01/28/2023]
Abstract
We analysed the impact of recreational drug use (RDU) on different outcomes in people living with HIV (PLHIV). A multicentre retrospective cohort study was performed with two cohorts of PLHIV included: people using recreational drugs (PURD) vs. people not using recreational drugs (PNURD). Overall, 275 PLHIV were included. RDU was associated with men having sex with men (OR 4.14, 95% CI [1.14, 5.19]), previous sexually transmitted infections (OR 4.00, 95% CI [1.97, 8.13]), and current smoking (OR 2.74, 95% CI [1.44, 5.19]). While the CD4/CD8 ratio increased amongst PNURD during the follow-up year, it decreased amongst PURD (p = 0.050). PURD presented lower scores of self-reported and multi-interval antiretroviral adherence (p = 0.017, and p = 0.006, respectively), emotional well-being (p < 0.0001), and regular follow-up (p = 0.059), but paid more visits to the emergency unit (p = 0.046). RDU worsens clinical, immunological, and mental health outcomes amongst PLHIV.
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Affiliation(s)
- Vanessa Castro-Granell
- Doctoral Programme in Pharmacy, Granada University, Granada, Spain
- Department of Pharmacy, Hospital Marina Baixa, Av. Alcalde En Jaume Botella Mayor, 7, 03570 Villajoyosa, Alicante Spain
| | - Noé Garin
- Department of Pharmacy, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- School of Health Science Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ángeles Jaén
- Research Unit, Fundació Docència i Recerca mutua Terrassa. Universidad de Barcelona, Terrassa, Barcelona Spain
| | - José Luis Casado
- Department of Infectious Diseases, Hospital Ramón y Cajal, Madrid, Spain
| | - Lorna Leal
- Infectious Diseases-HIV Unit, Hospital Clínic Barcelona- IDIBAPS, Barcelona, Spain
| | - Santiago Cenoz
- Medical Department, ViiV Healthcare, Tres Cantos, Madrid Spain
| | - María José Fuster-RuizdeApodaca
- Spanish Interdisciplinary AIDS Society (Sociedad Española Interdisciplinaria del Sida, SEISIDA), Madrid, Spain
- Department of Social and Organizational Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Exploring Residential Models of Care for Treatment of Infectious Complications Among People Who Inject Drugs: a Systematic Review. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Tsai J, Suh L, Annie F, Richmond BK. Substance Abuse–Related Soft Tissue Infections: A Uniquely Complicated Subset of a Common Problem. Am Surg 2019. [DOI: 10.1177/000313481908500744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We hypothesize that soft tissue infections (SSIs) related to intravenous drug usage (IVDU) are associated with a more complicated and costly course than those not associated with IVDU. For the period 2005–2018, ICD 9/ICD 10 billing codes were used to identify patients admitted with SSIs and their causes/complications and associated costs. IVDU-related infections were then compared with non-IVDU–related infections. t test was used to compare treatment costs and length of stay. Logistic regression analysis was used to assess the likelihood/risk of specific events in the IVDU versus non-IVDU populations. Of 47,281 patients admitted with SSIs, 1323 were associated with IVDU. IVDU-related patients tended to be younger (36.2 vs 49.3 years, P = 0.001). Both cost and length of stay were significantly greater in the IVDU group ($30,471 vs $16,020, P = 0.001; 5.7days vs 3.7days, P = 0.001). In addition, IVDU admissions were more likely to be associated with chronic blood-borne infections (hepatitis B/C, HIV, P = 0.001) and a significantly greater incidence of secondary infectious complications, including endocarditis ( P = 0.001), bacteremia ( P = 0.001), and osteomyelitis ( P = 0.003). SSI admissions related to IVDU are a unique subgroup of patients. These patients not only have longer and more costly lengths of stay but are also at higher risk for secondary complications such as chronic blood-borne viral illness and secondary bacterial infectious complications, such as bacteremia, endocarditis, and osteomyelitis. Further prospective study of these findings is warranted as we continue to battle the growing problem of IVDU in the United States
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Affiliation(s)
- Jonathon Tsai
- Department of Surgery, Charleston Area Medical Center, Charleston, West Virginia
| | - Lily Suh
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Frank Annie
- Charleston Area Medical Center Health Education and Research Institute, Charleston, West Virginia; and
| | - Bryan K. Richmond
- Department of Surgery, West Virginia University–Charleston Division, Charleston, West Virginia
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Moradi-Joo M, Ghiasvand H, Noroozi M, Armoon B, Noroozi A, Karimy M, Rostami A, Mirzaee MS, Hemmat M. Prevalence of skin and soft tissue infections and its related high-risk behaviors among people who inject drugs: A systematic review and meta-analysis. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1572805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Mohammad Moradi-Joo
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Alireza Noroozi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Psychiatrists, Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Karimy
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR, Iran
| | - Mohammad Saeed Mirzaee
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Morteza Hemmat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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Nordeck CD, Welsh C, Schwartz RP, Mitchell SG, Cohen A, O’Grady KE, Gryczynski J. Rehospitalization and substance use disorder (SUD) treatment entry among patients seen by a hospital SUD consultation-liaison service. Drug Alcohol Depend 2018; 186. [PMID: 29529456 PMCID: PMC5922267 DOI: 10.1016/j.drugalcdep.2017.12.043] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Substance use disorders (SUD) are associated with non-adherence to medical care and high utilization of hospital services. This study characterized patterns and correlates of rehospitalization among patients seen by a hospital-based SUD consultation-liaison (CL) team. METHODS This study was a retrospective medical record review of patients in a large urban academic hospital who received SUD consultation and were diagnosed with opioid, cocaine, and/or alcohol use disorder (N = 267). Data were collected on patient characteristics, substance-specific SUD diagnoses (opioids, cocaine, and alcohol), opioid agonist treatment (OAT) with methadone or buprenorphine (treatment status at admission; in-hospital initiation of OAT), and rehospitalization through 180 days post-discharge. Associations with rehospitalization were examined using bivariate tests of independence and multivariate logistic regression, with patient background and medical characteristics, substance-specific SUD diagnoses, and OAT status (at admission and in-hospital initiation) as predictors. RESULTS Rehospitalization rates were higher among patients with current opioid (38% vs. 24%; p < .05) and cocaine use disorders (39% vs. 26%; p < .05) compared to patients without these diagnoses. In multivariate logistic regression analysis, the number of medical comorbidities [Adjusted Odds Ratio (AOR) = 1.2; p < .01] and opioid use disorder (AOR = 2.4, p < .05) were independently associated with rehospitalization. CONCLUSIONS In this sample of hospital patients receiving SUD CL services, the risk of rehospitalization differed by type of SUD diagnosis. In-hospital initiation of OAT is promising for facilitating treatment linkage post-discharge, but this small study did not show differences in rehospitalization based on OAT initiation. These findings could inform services for hospital patients with comorbid SUDs.
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Affiliation(s)
- Courtney D. Nordeck
- Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA
| | - Christopher Welsh
- Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Robert P. Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA
| | | | - Art Cohen
- Department of Psychiatry, Division of Alcohol and Drug Abuse, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD 21201, USA
| | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD 20742, USA
| | - Jan Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103. Baltimore, MD 21201, USA.
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Kendall CE, Boucher LM, Mark AE, Martin A, Marshall Z, Boyd R, Oickle P, Diliso N, Pineau D, Renaud B, Rose T, LeBlanc S, Tyndall M, Lee OM, Bayoumi AM. A cohort study examining emergency department visits and hospital admissions among people who use drugs in Ottawa, Canada. Harm Reduct J 2017; 14:16. [PMID: 28494791 PMCID: PMC5427560 DOI: 10.1186/s12954-017-0143-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background The health of people who use drugs (PWUD) is characterized by multimorbidity and chronicity of health conditions, necessitating an understanding of their health care utilization. The objective of this study was to evaluate emergency department (ED) visits and hospital admissions among a cohort of PWUD. Methods We used a retrospective observational design between 2012 and 2013. The population was a marginalized cohort of PWUD (the PROUD study) for whom survey data was linked (n = 663) to provincial health administrative data housed at the Institute for Clinical Evaluative Sciences. We constructed a 5:1 comparison group matched by age, sex, income quintile, and region. The main outcomes were defined as having two or more ED visits, or one or more hospital admissions, in the year prior to survey completion. We used multivariable logistic regression analyses to identify factors associated with these outcomes. Results Compared to the matched cohort, PWUD had higher rates of ED visits (rate ratio [RR] 7.0; 95% confidence interval [95% CI] 6.5–7.6) and hospitalization (RR 7.7; 95% CI 5.9–10.0). After adjustment, factors predicting more ED visits were receiving disability (adjusted odds ratio [AOR] 3.0; 95% CI 1.7–5.5) or income assistance (AOR 2.7; 95% CI 1.5–5.0), injection drug use (AOR 2.1; 95% CI 1.3–3.4), incarceration within 12 months (AOR 1.6; 95% CI 1.1–2.4), mental health comorbidity (AOR 2.1; 95% CI 1.4–3.1), and a suicide attempt within 12 months (AOR 2.1; 95% CI 1.1–3.4). Receiving methadone (AOR 0.5; 95% CI 0.3–0.9) and having a regular family physician (AOR 0.5; 95% CI 0.2–0.9) were associated with lower odds of having more ED visits. Factors associated with more hospital admissions included Aboriginal identity (AOR 2.4; 95% CI 1.4–4.1), receiving disability (AOR 2.4; 95% CI 1.1–5.4), non-injection drug use (opioids and non-opioids) (AOR 2.2; 95% CI 1.1–4.4), comorbid HIV (AOR 2.4; 95% CI 1.2–5.6), mental health comorbidity (AOR 2.4; 95% CI 1.3–4.2), and unstable housing (AOR 1.9; 95% CI 1.0–3.4); there were no protective factors for hospitalization. Conclusions Improved post-incarceration support, housing services, and access to integrated primary care services including opioid replacement therapy may be effective interventions to decrease acute care use among PWUD, including targeted approaches for people receiving social assistance or with mental health concerns.
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Affiliation(s)
- Claire E Kendall
- Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada.
| | - Lisa M Boucher
- Bruyère Research Institute, 43 Bruyère Street (Annex E), Ottawa, ON, K1N 5C8, Canada
| | - Amy E Mark
- Institute for Clinical Evaluative Sciences, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, ON, K1Y 4E9, Canada
| | - Alana Martin
- Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada
| | - Zack Marshall
- Social Development Studies and School of Social Work, Renison University College-University of Waterloo, 240 Westmount Road North, Waterloo, ON, N2L 3G4, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, 221 Nelson Street, Ottawa, ON, K1N 1C7, Canada
| | - Pam Oickle
- Ottawa Public Health, 179 Clarence St, Ottawa, ON, K1N 5P7, Canada
| | - Nicola Diliso
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Dave Pineau
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Brad Renaud
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Tiffany Rose
- PROUD Community Advisory Committee, Ottawa, ON, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, ON, Canada.,Drug Users Advocacy League, Ottawa, ON, Canada
| | - Mark Tyndall
- BC Centre for Disease Control, 655W 12th Avenue, Vancouver, BC, V5Z 4R4, Canada
| | - Olivia M Lee
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8 L1, Canada
| | - Ahmed M Bayoumi
- Institute for Clinical Evaluative Sciences, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Box 684, Administrative Services Building, 1st Floor, Ottawa, ON, K1Y 4E9, Canada.,Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada.,Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto ON 30 Bond St, Toronto, ON, M5B 1 W8, Canada
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11
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Injection-site vein loss and soft tissue abscesses associated with black tar heroin injection: A cross-sectional study of two distinct populations in USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 39:21-27. [PMID: 27768990 DOI: 10.1016/j.drugpo.2016.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Injection-site vein loss and skin abscesses impose significant morbidity on people who inject drugs (PWID). The two common forms of street heroin available in the USA include black tar and powder heroin. Little research has investigated these different forms of heroin and their potential implications for health outcomes. METHODS A multiple-choice survey was administered to a sample of 145 participants seeking services at reduction facilities in both Sacramento, CA and greater Boston, MA, USA. Multivariate regression models for reporting one or more abscesses in one year, injection-site veins lost in six months, and soft tissue injection. RESULTS Participants in Sacramento exclusively used black tar (99%), while those in Boston used powder heroin (96%). Those who used black tar heroin lost more injection-site veins (β=2.34, 95% CI: 0.66-4.03) and were more likely to report abscesses (AOR=7.68, 95% CI: 3.01-19.60). Soft tissue injection was also associated with abscesses (AOR=4.68, 95% CI: 1.84-11.93). Consistent venous access (AOR: 0.088, 95% CI: 0.011-0.74) and losing more injection sites (AOR: 1.22, 95% CI: 1.03-1.45) were associated with soft tissue injection. CONCLUSION Use of black tar heroin is associated with more frequent abscesses and more extensive vein loss. Poor venous access predisposes people who inject drugs to soft tissue injection, which may constitute a causal pathway between black tar heroin injection and abscess formation. The mechanisms by which black tar heroin contributes to vein loss and abscess formation must be further elucidated in order to develop actionable interventions for maintaining vein health and decreasing the abscess burden. Potential interventions include increased access to clean injection equipment and education, supervised injection facilities, opioid substitution therapy, and supply chain interventions targeting cutting agents.
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Grewal HK, Ti L, Hayashi K, Dobrer S, Wood E, Kerr T. Illicit drug use in acute care settings. Drug Alcohol Rev 2015; 34:499-502. [PMID: 25944526 DOI: 10.1111/dar.12270] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/08/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS While persons with addiction are often hospitalised, hospitals typically employ abstinence-based policies specific to illicit drug use. Although illicit drug use is known to occur within hospitals, this problem has not been well characterised. Therefore, we sought to investigate the prevalence of and factors associated with having ever used drugs in hospital among people who use drugs in Vancouver, Canada. DESIGN AND METHODS Data were derived from prospective cohort studies of people who use drugs between December 2012 and May 2013. Multivariable logistic regression was used to identify demographic and behavioural factors associated with having ever used illicit drugs in hospital. RESULTS Among 1028 participants who had experienced ≥1 hospitalisation, 43.9% reported having ever used drugs while hospitalised. In multivariable analyses, factors positively associated with having ever used drugs in hospital included daily cocaine injection and daily crack non-injection (both P < 0.05). Factors negatively associated with the outcome included older age and male gender (both P < 0.05). The most common reasons for drug use in hospital were 'wanting to use' and 'being in withdrawal'. Drugs were most commonly used in patient washrooms. DISCUSSION AND CONCLUSIONS Our findings demonstrate that an abstinence-based approach to drug use in hospitals may be ineffective at prohibiting drug consumption. High-risk drug use behaviours arising from ongoing drug use may pose risks for further harm and illness. Efforts to minimise the harms associated with using drugs in hospital are urgently needed. [Grewal HK, Ti L, Hayashi K, Dobrer S, Wood E, Kerr T. Illicit drug use in acute care settings. Drug Alcohol Rev 2015;34:499-502].
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Affiliation(s)
- Harjot Kaur Grewal
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Sabina Dobrer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.,Department of Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Galyfos G, Palogos K, Kavouras N. Septic internal jugular vein thrombosis caused by Fusobacterium necrophorum and mediated by a broken needle. ACTA ACUST UNITED AC 2014; 46:911-5. [DOI: 10.3109/00365548.2014.952247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Healthcare seeking and hospital admissions by people who inject drugs in response to symptoms of injection site infections or injuries in three urban areas of England. Epidemiol Infect 2014; 143:120-31. [PMID: 24568684 DOI: 10.1017/s0950268814000284] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
People who inject drugs (PWID) are vulnerable to infections and injuries at injection sites. The factors associated with reporting symptoms of these, seeking related advice, and hospital admission are examined. PWID were recruited in Birmingham, Bristol and Leeds using respondent-driven sampling (N = 855). During the preceding year, 48% reported having redness, swelling and tenderness (RST), 19% an abscess, and 10% an open wound at an injection site. Overall, 54% reported ⩾1 symptoms, with 45% of these seeking medical advice (main sources emergency departments and General Practitioners). Advice was often sought ⩾5 days after the symptom first appeared (44% of those seeking advice about an abscess, 45% about an open wound, and 35% for RST); the majority received antibiotics. Overall, 9·5% reported hospital admission during the preceding year. Ever being diagnosed with septicaemia and endocarditis were reported by 8·8% and 2·9%, respectively. Interventions are needed to reduce morbidity, healthcare burden and delays in accessing treatment.
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Potential role of safer injection facilities in reducing HIV and hepatitis C infections and overdose mortality in the United States. Drug Alcohol Depend 2011; 118:100-10. [PMID: 21515001 DOI: 10.1016/j.drugalcdep.2011.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 03/08/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Safer injection facilities (SIFs) reduce risks associated with injecting drugs, particularly public injection and overdose mortality. They exist in many countries, but do not exist in the United States. We assessed several ethical, operational, and public health considerations for establishing SIFs in the United States. METHOD We used the six-factor Kass framework (goals, effectiveness, concerns, minimization of concerns, fair implementation, and balancing of benefits and concerns), summarized needs of persons who inject drugs in the United States, and reviewed global evidence for SIFs. RESULTS SIFs offer a hygienic environment to inject drugs, provide sterile injection equipment at time of injection, and allow for safe disposal of used equipment. Injection of pre-obtained drugs, purchased by persons who inject drugs, happens in a facility where trained personnel provide on-site counseling and referral to addiction treatment and health care and intervene in overdose emergency situations. SIFs provide positive health benefits (reducing transmission of HIV and viral hepatitis, bacterial infections, and overdose mortality) without evidence for negative health or social consequences. SIFs serve most-at-risk persons, including those who inject in public or inject frequently, and those who do not use other public health programs. It is critical to address legal, ethical, and local concerns, develop and implement relevant policies and procedures, and assess individual- and community-level needs and benefits of SIFs given local epidemiologic data. CONCLUSIONS SIFs have the potential to reduce viral and bacterial infections and overdose mortality among those who engage in high-risk injection behaviors by offering unique public health services that are complementary to other interventions.
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16
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Superior Cluneal Nerve Block for Treatment of Buttock Abscesses in the Emergency Department. J Emerg Med 2010; 39:83-5. [DOI: 10.1016/j.jemermed.2009.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 08/11/2009] [Accepted: 08/30/2009] [Indexed: 11/19/2022]
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Pollini RA, Gallardo M, Hasan S, Minuto J, Lozada R, Vera A, Zúñiga ML, Strathdee SA. High prevalence of abscesses and self-treatment among injection drug users in Tijuana, Mexico. Int J Infect Dis 2010; 14 Suppl 3:e117-22. [PMID: 20381396 DOI: 10.1016/j.ijid.2010.02.2238] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 09/11/2009] [Accepted: 02/04/2010] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Soft tissue infections are common among injection drug users (IDUs), but information on correlates and treatment in this highly marginalized population is lacking. METHODS Six hundred twenty-three community-recruited IDUs in Tijuana, Mexico, completed a detailed interview on abscess history and treatment. Univariate and multiple logistic regressions were used to identify factors independently associated with having an abscess in the prior 6 months. RESULTS Overall, 46% had ever had an abscess and 20% had had an abscess in the past 6 months. Only 12% had sought medical care for their most recent abscess; 60% treated the abscess themselves. The most common self-treatment method was to apply heated (24%) or unheated (23%) Aloe vera leaf. Other methods included draining the wound with a syringe (19%) or knife (11%). Factors independently associated with recent abscess were having income from sex work (adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI) 2.08-10.00), smoking methamphetamine (aOR 1.65, 95% CI 1.05-2.62), seeking someone to help with injection (aOR 2.06, 95% CI 1.18-3.61), and reporting that police affected where they used drugs (aOR 2.14, 95% CI 1.15-3.96). CONCLUSIONS Abscesses are common among IDUs in this setting, but appropriate treatment is rare. Interventions to reduce barriers to medical care in this population are needed. Research on the effectiveness of Aloe vera application in this setting is also needed, as are interventions to provide IDU sex workers, methamphetamine smokers, and those who assist with injection with the information and equipment necessary to reduce abscess risk.
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Affiliation(s)
- Robin A Pollini
- Department of Medicine, University of California-San Diego, La Jolla, CA 92093, USA.
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18
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The extent of injection site infection in injecting drug users: findings from a national surveillance study. Epidemiol Infect 2010; 138:1510-8. [DOI: 10.1017/s0950268810000324] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYInjection site infections in injecting drug users (IDUs) are associated with serious morbidity and healthcare costs. Factors associated with symptoms of these were examined through annual (2006–2008) unlinked-anonymous survey of IDUs in England, Wales and Northern Ireland. Overall 36% (1863/5209) self-reported having a symptom with no trend over time (35% 2006, 37% 2007, 34% 2008). Symptoms were less common in the North East of England; increased with years injecting; and were higher in women, those recently homeless, those recently using a needle exchange, and those injecting both opiates and stimulants. Of those injecting during the previous 4 weeks (n=3733) symptoms were associated with: injecting daily; injecting ⩾10 times a day; injecting into hands, groin, or legs; sharing filters; and reusing water to flush syringes. Symptoms of injection site infections are common in IDUs. Better-targeted preventive interventions are needed, and continued surveillance should assist with assessing the impact of new initiatives.
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Nalmas S, Bishburg E, Shah M, Chan T. Skin and Soft Tissue Abscess: 1 Year's Experience. J Cutan Med Surg 2009; 13:257-61. [DOI: 10.2310/7750.2009.08073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The incidence of skin and soft tissue abscesses (SSTAs) has increased owing to the emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Some of these patients are treated as outpatients (OPs) and some as inpatients (IPs). Objective: To review the microbiology and clinical features of SSTAs and the clinical parameters that may have influenced clinicians to treat patients as IPs. Methods: The study was conducted in a 673-bed teaching hospital between January and December 2005. A retrospective chart review of patients identified from a microbiology culture log was conducted. Data were collected for demographics, underlying disease, SSTA number and site, recurrence rates, and clinical presentation. Results: One hundred thirty-eight patients were identified; 76 (55%) were female, with a mean age of 42 years (range 18–80 years); 76 (55.5%) had no underlying disease, 27 (19.6%) had diabetes, 20 (14.5%) had human immunodeficiency virus (HIV) infection, and 13 (9.4%) were intravenous drug users. Common SSTA sites involved were the perineal area (43; 31.2%), upper extremities (35; 25.4%), lower extremities (19; 13.8%), head and neck (14; 10.1%), chest (13; 9.4%), and abdomen (8; 5.8%). Conclusions: CA-MRSA was the most commonly isolated organism overall and in patients treated as OPs. The decision to treat SSTA patients as IPs seems to be influenced by SSTA number and site and the presence of fever at presentation. SSTA number and site (variables that led to the decision to treat patients as IPs) were confirmed by demonstrating statistical significance in the analysis between the IP and OP groups, but the other determinant of admission, the presence of fever at presentation, was based on chart review statements and not confirmed by statistical analysis between the IP and OP groups.
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Affiliation(s)
- Sandhya Nalmas
- From the Division of Infectious Diseases and Departments of Pharmacy and Microbiology, Newark Beth Israel Medical Center, Newark, NJ
| | - Eliahu Bishburg
- From the Division of Infectious Diseases and Departments of Pharmacy and Microbiology, Newark Beth Israel Medical Center, Newark, NJ
| | - Monica Shah
- From the Division of Infectious Diseases and Departments of Pharmacy and Microbiology, Newark Beth Israel Medical Center, Newark, NJ
| | - Trini Chan
- From the Division of Infectious Diseases and Departments of Pharmacy and Microbiology, Newark Beth Israel Medical Center, Newark, NJ
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Williamson A, Darke S, Ross J, Teesson M. Changes and predictors of change in the physical health status of heroin users over 24 months. Addiction 2009; 104:465-70. [PMID: 19207357 DOI: 10.1111/j.1360-0443.2008.02475.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIMS (i) To describe the course of physical health among the ATOS cohort over 24 months; and (ii) to examine the effects of treatment, drug use patterns and social and psychological factors on health status over 24 months. DESIGN Longitudinal cohort. SETTING Sydney, Australia. PARTICIPANTS A total of 615 heroin users recruited for the Australian Treatment Outcome Study (ATOS). FINDINGS The general health of the cohort improved significantly over 24 months. Significant predictors of poor health over 24 months were: being older, being female, past month heroin, other opiate and tobacco use, past month unemployment and current major depression. Spending a greater proportion of time in residential rehabilitation (RR) was associated with better health over 24 months. No other treatment factors demonstrated a significant, independent relationship with health. CONCLUSIONS The physical health of dependent heroin users is affected by drug use and psychosocial problems. RR treatment appears to be particularly beneficial to the health of heroin users, suggesting the importance of a comprehensive approach to improving health among this group.
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Affiliation(s)
- Anna Williamson
- School of Public Health and Community Medicine, University of New South Wales, NSW, Australia.
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21
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HIV seropositivity predicts longer duration of stay and rehospitalization among nonbacteremic febrile injection drug users with skin and soft tissue infections. J Acquir Immune Defic Syndr 2009; 49:398-405. [PMID: 19186352 DOI: 10.1097/qai.0b013e318183ac84] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin/soft tissue infections (SSTIs) are the leading cause of hospital admissions among injection drug users (IDUs). METHODS We performed a retrospective investigation to determine the epidemiology of SSTIs (ie, cellulitis and/or abscesses) in febrile IDUs, with a focus on bacteriology and potential predictors of increased health care utilization measured by longer length of stay and rehospitalization. Subjects were drawn from a cohort of febrile IDUs presenting to an inner-city emergency department from 1998 to 2004. RESULTS Of the 295 febrile IDUs with SSTIs, specific discharge diagnoses were cellulitis only (n = 143, 48.5%), abscesses only (n = 113, 38.3%), and both (n = 39, 13.2%). Documented HIV infection rate was 28%. Of note, 10 subjects were newly diagnosed with HIV infection during their visits. Staphylococcus aureus was the leading pathogen, and increasing rates of methicillin-resistant S. aureus emerged over time (before 2001: 4%, 2001-2004: 56%, P < 0.01). HIV seropositivity predicted rehospitalization within 90 days [adjusted hazard ratios and 95% confidence intervals: 2.90 (1.20 to 7.02)]. HIV seropositivity also predicted increased length of stay in those who were nonbacteremic [adjusted hazard ratios and 95% confidence intervals: 1.49 (1.11 to 2.01)]. CONCLUSIONS Among febrile IDUs with SSTIs, a strong association between HIV seropositivity and health care resource utilization was found. Accordingly, attention to HIV serostatus should be considered in clinical disposition decisions for this vulnerable high-risk population.
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Hope V, Kimber J, Vickerman P, Hickman M, Ncube F. Frequency, factors and costs associated with injection site infections: findings from a national multi-site survey of injecting drug users in England. BMC Infect Dis 2008; 8:120. [PMID: 18801177 PMCID: PMC2600824 DOI: 10.1186/1471-2334-8-120] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 09/18/2008] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Injection site infections among injecting drug users (IDUs) have been associated with serious morbidity and health service costs in North America. This study explores the frequency, factors and costs associated with injection site infections among IDUs in England. METHODS Unlinked-anonymous survey during 2003/05 recruiting IDUs from community settings at seven locations across England. Self-reported injecting practice, symptoms of injection site infections (abscess or open wound) and health service utilisation data were collected using a questionnaire, participants also provided dried blood spot samples (tested for markers blood borne virus infections). Cost estimates were obtained by combining questionnaire data with information from national databases and the scientific literature. RESULTS 36% of the 1,058 participants reported an injection site infection in the last year. Those reporting an injection site infection were more likely to be female and aged over 24, and to have: injected into legs, groin, and hands in last year; injected on 14 or more days during the last four weeks; cleaned needles/syringes for reuse; injected crack-cocaine; antibodies to hepatitis C; and previously received prescribed substitute drug. Two-thirds of those with an injection site infection reported seeking medical advice; half attended an emergency department and three-quarters of these reported hospital admission. Simple conservative estimates of associated healthcare costs range from pound 15.5 million per year to as high as pound 30 million; though if less conservative unit costs assumptions are made the total may be much higher (pound 47 million). The vast majority of these costs are due to hospital admissions and the uncertainty is due to little data on length of hospital stays. CONCLUSION Symptoms of injection site infections are common among IDUs in England. The potential costs to the health service are substantial, but these costs need more accurate determination. Better-targeted interventions to support safer injection need to be developed and evaluated. The validity of self-reported symptoms, and the relationship between symptoms, infection severity, and health seeking behaviour require further research.
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Affiliation(s)
- Vivian Hope
- Centre for Infections, Health Protections Agency, London, UK
- Centre for Research on Drugs & Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK
| | - Jo Kimber
- Centre for Research on Drugs & Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK
- Department of Social Medicine, University of Bristol, Bristol, UK
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
| | - Peter Vickerman
- Centre for Research on Drugs & Health Behaviour, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Hickman
- Department of Social Medicine, University of Bristol, Bristol, UK
| | - Fortune Ncube
- Centre for Infections, Health Protections Agency, London, UK
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Allison DC, Miller T, Holtom P, Patzakis MJ, Zalavras CG. Microbiology of upper extremity soft tissue abscesses in injecting drug abusers. Clin Orthop Relat Res 2007; 461:9-13. [PMID: 17563706 DOI: 10.1097/blo.0b013e31811f3526] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Drug injection often results in upper extremity soft tissue infections. We determined the bacteriology of soft tissue abscesses in substance abusers who inject drugs to provide guidelines for empiric antibiotic therapy. We retrospectively studied 855 patients (638 men and 217 women; mean age, 41.5 years) with a history of injecting illicit drugs and a diagnosis of an upper extremity soft tissue abscess. In the 694 patients with positive cultures the most common organism was Staphylococcus aureus, identified in 359 of 694 patients (52%). An increase in the incidence of oxacillin-resistant S. aureus over time was observed. Oxacillin-resistant S. aureus comprised 5% of S. aureus infections in 1999, 50% in 2001, 56% in 2003, and 82% in 2005. Microaerophilic streptococci were present in 37% of culture-positive cases and other anaerobes in 10%. Infections were monomicrobial in 366 of 694 patients (53%) and polymicrobial in 328 of 694 patients (47%). S. aureus is the most common pathogen in soft tissue abscesses in injecting drug abusers with an increasing incidence of oxacillin-resistant S. aureus. In addition to surgical decompression of abscesses, broad-spectrum empiric antibiotic therapy is necessary.
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Affiliation(s)
- Daniel Christopher Allison
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, LAC + USC Medical Center, Los Angeles, CA 90033, USA
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Takahashi TA, Baernstein A, Binswanger I, Bradley K, Merrill JO. Predictors of hospitalization for injection drug users seeking care for soft tissue infections. J Gen Intern Med 2007; 22:382-8. [PMID: 17356973 PMCID: PMC1824763 DOI: 10.1007/s11606-006-0079-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Soft tissue infections (STIs) from injection drug use are a common cause of Emergency Department visits, hospitalizations, and operating room procedures, yet little is known about factors that may predict the need for these costly medical services. OBJECTIVE To describe a cohort of injection drug users seeking Emergency Department care for STIs and to identify risk factors associated with hospitalization. We hypothesized that participants who delayed seeking care would be hospitalized more often than those who did not. DESIGN Cohort study using in-person structured interviews and medical record review. Logistic regression assessed the association between hospital admission and delay in seeking care as well as other demographic, clinical, and psychosocial factors. PARTICIPANTS Injection drug users who sought Emergency Department care for STIs from May 2001 to March 2002. RESULTS Of the 136 participants, 55 (40%) were admitted to the hospital. Delay in seeking care was not associated with hospital admission. Participants admitted for their infection were significantly more likely to be living in a shelter (P = .01) and to report being hospitalized 2 or more times in the past year (P < .01). CONCLUSIONS We identified a subpopulation of injection drug users, mostly living in shelters, who were hospitalized frequently in the past year and who were more likely to be hospitalized for their current infections compared to others. As members of this subpopulation can be easily identified and located, they may benefit from interventions to reduce the health care utilization resulting from these infections.
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Groin injecting in the context of crack cocaine and homelessness: From ‘risk boundary’ to ‘acceptable risk’? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2006. [DOI: 10.1016/j.drugpo.2006.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Draus PJ, Carlson RG. Needles in the haystacks: the social context of initiation to heroin injection in rural Ohio. Subst Use Misuse 2006; 41:1111-24. [PMID: 16798679 DOI: 10.1080/10826080500411577] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semistructured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities.
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Affiliation(s)
- Paul J Draus
- Department of Behavioral Sciences, The University of Michigan-Dearborn, Dearborn, Michigan, USA.
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Abstract
PURPOSE OF REVIEW Heroin use is associated with numerous adverse sequelae. As clinical services develop, addiction psychiatrists will increasingly be called upon to help identify and manage the complications of heroin use. This review focuses on recent research into the medical complications of heroin use and looks at strategies to minimize harm associated with this practice. RECENT FINDINGS Mortality associated with heroin overdose has increased substantially in many countries. Parenteral use of opioid drugs is a central factor and other risk factors include polydrug use, particularly benzodiazepines and alcohol, mental health issues and environmental factors not conducive to resuscitation. Unravelling the determinants of blood-borne virus transmission continues, the focus shifting from needle sharing to inadvertent sharing of other injecting equipment. Trials addressing the challenges of antiviral therapy in injecting drug users are emerging. A greater understanding of the effects of opioids on immune functioning complements our knowledge of infection in the heroin-using group as well as possibly explaining the reduced response to vaccination in this group. SUMMARY Medical complications of heroin affect a number of different organ systems. The role of the addiction specialist is to be aware of these so that early diagnosis and appropriate management is instituted. The latter will generally be done in collaboration with other specialists. The addictions specialist can play a significant role in the development of clinical systems to minimize these complications.
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